How does sleep affect the weight loss journey? We asked a husband-and-wife team of medical experts

(BPT) - As a sleep medicine specialist, Dr. Christopher J. Allen knows well the importance of sleep health, which is not only defined by the number of hours the individual sleeps, but also the quality of the sleep and the absence of sleep disorders¹. He regularly sees patients who have conditions like obstructive sleep apnea (OSA), where obesity can be a significant risk factor. And when it comes to helping those patients address weight challenges, he knows another doctor who comes highly recommended: weight management specialist Dr. Dafina Allen. As a husband-and-wife team, the Allens often share patients between them because of the significant interplay between obesity and sleep health.

OSA is sleep disordered breathing that occurs when the throat muscles relax during sleep, blocking the airway, and it affects more than 54 million Americans². It can lead to drowsiness and fatigue during the day, but can also increase the risk for heart attack, heart failure, stroke and contributes to high blood pressure³. By some estimates, moderate-to-severe OSA can increase mortality risk by 33%⁴. Obesity is a significant risk factor for OSA, occurring in an estimated 41% to 70% of patients with the condition^5,6.

Sleep health and the challenge of weight loss

“When patients come to see me, they often know that weight plays some role with sleep apnea,” says Chris. “And it’s true that, for many patients, weight loss can reduce the severity of sleep apnea. But achieving that is where getting the right treatment and support matters.”

“I have patients — many of whom wind up working with Chris — who realize that their weight loss isn’t progressing because they’re not getting quality sleep,” Dafina adds. “When you aren’t sleeping well, your cortisol levels are higher, increasing your visceral fat. You tend to be more irritable; you may want to snack more and be less motivated to be active. Having an untreated sleep condition like OSA is going to be a major barrier to managing your weight in a healthy way.”

Research has shown that the relationship between OSA and weight can be reciprocal with some studies showing that obesity increases the risks of developing OSA, but also that treating OSA may help spur weight loss⁷.

Chris relies on positive airway pressure (PAP) therapy, using a device such as ResMed CPAP (continuous positive airway pressure) machines as the first line treatment for OSA. CPAP uses airflow to keep the airways open during sleep, and provides relief from the symptoms of OSA, which can make it easier to make the lifestyle changes needed to address obesity concerns, according to Chris.

“Sleep apnea can be overwhelming, but once a patient begins using CPAP, they often start to notice a difference,” adds Chris. “That extra energy from proper sleep may help kickstart healthier lifestyle choices. When we work with patients on sleep health issues and start to educate them about how weight may affect those conditions, they are in a better spot to adhere to treatment plans and achieve better health outcomes.”

“Simply starting the conversation is a critical part of a health journey, and with the addition of GLP-1 medications as a tool for weight management, we are seeing more people interested in engaging their doctors about weight and health in general,” Dafina adds. “As part of that, I’ve heard many more questions about sleep health. Sleep is such a critical piece of the weight loss puzzle. If a patient isn’t sleeping well, it’s going to be harder to follow a plan that requires them to change how they eat and increase their activity level, even with the help of new medications.”

Healthy weight management and successful OSA treatment

“We’ve been prescribing these medications for diabetes for some time, and with more people being prescribed GLP-1s for obesity, we’re constantly increasing what we know about how effective they are and the role they can play in healthy weight management,” adds Dafina.

While weight loss can reduce the severity of sleep apnea, her husband chimes in that it’s important to keep your healthcare professional involved in your sleep health decisions even if you have lost significant weight and feel less tired during the day.

“I’d usually want to do a sleep study to determine the impact of the weight loss on the sleep apnea before making any changes to treatment,” he says. “But we also want to make sure that if you are using one of these new medications that the weight you’ve lost remains or continues to improve once you come off the medication. If it goes back up, you are at risk of your sleep apnea getting worse once again, so we want to see people making long-term sustainable changes and make sure they stay vigilant if anything changes regarding their sleep health.”

Sleep apnea: Are you at risk?

“The hardest part of my job is that I have to talk to patients about things that happen when they’re unconscious,” adds Chris. “Many people don’t know that they have a sleep disorder and so it’s important to know your risk factors. If you have a bed partner, rely on them to let you know if you’re snoring or gasping for air at night, because that is a common sign of sleep apnea.”

For people who sleep alone, other signs that may indicate OSA include waking up frequently during the night or waking up with headaches. Diagnosing obstructive sleep apnea requires talking to a health professional, but signs and symptoms include feeling tired during the day, snoring loudly at night, waking in the middle of the night gasping for air, having a body mass index over 30, or history of high blood pressure⁸.

It’s estimated that up to 80% of adults with sleep apnea are undiagnosed and untreated, so knowing your risk factors and having a conversation with your doctor is critical⁹.

To learn more about the risk factors for obstructive sleep apnea and to find out how to talk to your healthcare professional about them, take a look at the sleep resource page at resmed.com.